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Ethical examination of deep brain stimulation's 'last resort' status


Stevens, I and Gilbert, F, Ethical examination of deep brain stimulation's 'last resort' status, Journal of Medical Ethics pp. 1-6. ISSN 1473-4257 (2021) [Refereed Article]

DOI: doi:10.1136/medethics-2020-106609


Deep brain stimulation (DBS) interventions are novel devices being investigated for the management of severe treatment-resistant psychiatric illnesses. These interventions require the invasive implantation of high-frequency neurostimulatory probes intracranially aiming to provide symptom relief in treatment-resistant disorders including obsessive-compulsive disorder and anorexia nervosa. In the scientific literature, these neurostimulatory interventions are commonly described as reversible and to be used as a last resort option for psychiatric patients. However, the ‘last resort’ status of these interventions is rarely expanded upon. Contrastingly, usages of DBS devices for neurological symptoms (eg, Parkinson’s disease, epilepsy or dystonia) have paved the way for established safety and efficacy standards when used earlier in a disease’s timeline. As DBS treatments for these neurological diseases progress to have earlier indications, there is a parallel ethical concern that early implementation may one day become prescribed for psychiatric illnesses. The purpose of this article is to build off contemporary understandings of reversible neurostimulatory interventions to examine and provide clarifications on the ‘last resort’ status of DBS to better address its ethically charged use in psychiatric neurosurgery. To do this, evaluative differences between DBS treatments will be discussed to demonstrate how patient autonomy would be a paramount guiding principle when one day implementing these devices at various points along a psychiatric disease’s timeline. In presenting the clarification of ‘last resort’ status, the ethical tensions of early DBS interventions will be better understood to assist in providing psychiatric patients with more quality of life years in line with their values.

Item Details

Item Type:Refereed Article
Keywords:deep brain stimulation, brain-computer interfaces, ethics, identify, personality
Research Division:Philosophy and Religious Studies
Research Group:Applied ethics
Research Field:Bioethics
Objective Division:Culture and Society
Objective Group:Ethics
Objective Field:Bioethics
UTAS Author:Stevens, I (Mr Ian Stevens)
UTAS Author:Gilbert, F (Dr Frederic Gilbert)
ID Code:142456
Year Published:2021
Deposited By:Philosophy and Gender Studies
Deposited On:2021-01-18
Last Modified:2021-02-10

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